Note: The job is a remote job and is open to candidates in USA. Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. The Senior Manager, Government Programs Operations leads the implementation and operational oversight of regulatory requirements for Exchange lines of business, including claims operations, regulatory reporting, audit readiness, and client deliverables. The role translates federal and state guidance into operational processes, system capabilities, and scalable solutions while driving compliance and performance.
Responsibilities
- Lead Government Programs support for Exchange operations, including claims adjudication, regulatory reporting, and audit support (Government and Client)
- Oversee day-to-day operational performance for Exchange programs, ensuring alignment with contractual, regulatory requirements, and client expectations
- Lead the interpretation, implementation, and monitoring of federal and state regulatory requirements impacting Exchange lines of business
- Collaborate cross-functionally with SMEs (Claims, Product, Technology, Compliance, Legal) to assess regulatory impacts and ensure timely, coordinated implementation of required changes
- Design, document, and scale operational processes that enable accurate, compliant, and efficient service delivery
- Define business and system requirements to support compliant claims processing, data accuracy, and reporting outcomes
- Lead regulatory reporting activities and ensure completeness, accuracy, and timeliness of all required submissions
- Support internal and external audits by federal and state agencies, including audit preparation, documentation, issue response, and remediation tracking
- Monitor Exchange program operations to identify and resolve issues, including root cause analysis and implementation of corrective actions
- Partner with stakeholders to manage error handling, operational exceptions, and process improvements across claims and reporting functions
- Identify opportunities to enhance operational performance, compliance, and scalability through process improvement and innovation
- Own and maintain documentation of policies and procedures, reporting specifications, job aids, and workflows for Government Programs Operations
- Maintain current knowledge of Exchange regulatory requirements and market trends to support compliance and strategic decision-making
- Provide data-driven insights to improve operational effectiveness, reporting accuracy, and overall program performance
- Foster a high-performance culture through mentoring, collaboration, and ongoing performance feedback
- Assess impact of new business and regulatory changes to ensure appropriate scalability, resource planning, and organizational readiness
Skills
- 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange programs
- 5+ years people management experience
- Subject matter expertise of Exchange regulatory requirements and associated product and/or operational workflows
- Demonstrated experience supporting regulatory reporting, audits, and compliance activities
- Extremely flexible, highly organized, and able to shift priorities easily
- Attention to detail & commitment to delivering high quality work product
- Excellent written and verbal communication skills
- Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities
- Strong operational mindset with experience improving processes and driving execution
- Ability to translate regulatory guidance into business and system requirements
- Extremely flexible, highly organized, and able to shift priorities in a fast-paced environment
- Strong analytical skills and experience leveraging data to support decision-making
- Attention to detail and commitment to delivering high-quality work product
- Excellent written and verbal communication skills
- Proven ability to manage cross-functional teams and build effective relationships across internal and external stakeholders, including government entities
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